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The prevalence of vesicoureteric reflux (VUR) has been estimated to be 2% of the child population.1 In children with VUR demonstrated on micturating cystourethrography there is a tendency for the grade of VUR to improve or for VUR to disappear with time and with increasing age.2 3 VUR has been identified as a risk factor for the development of urinary tract infections (UTI) and is present in a third of young children presenting with this problem. In addition, it is a risk factor for renal scarring, otherwise called reflux nephropathy.4 5 VUR is also associated with renal dysplasia and other developmental abnormalities of the urinary tract.6 There is now abundant evidence for inheritance by an autosomal dominant mechanism.7
Pathogenesis of reflux nephropathy
Studies have suggested that reflux nephropathy develops following UTI in very early childhood or infancy.8 New scars have been observed relatively infrequently; however, there are sufficient case reports of new scar formation both on intravenous urography and using 99mTc DMSA scans to accept that at least a proportion of renal scars are acquired following UTI.9 10 The probability that most scars develop in this way cannot be proved because relatively few children have serial imaging studies; in particular, few children have had imaging investigations before the first UTI. The link between UTI, VUR, and renal scarring has been confirmed by several independent groups.4 11 Smellieet al have also demonstrated a link between delay in diagnosis and treatment of UTI and the development of new renal scars.9 12
Symptoms and signs of VUR and reflux nephropathy
VUR and reflux nephropathy are silent conditions that do not usually give rise to symptoms or signs except when complications such as UTI develop. They can only be detected by invasive tests that are not routinely carried out in healthy children and are not …